Oral mucocele – A bump on the lower lip 

Oral mucocele

Oral mucocele is a non-cancerous mucous-filled cavity that can appear anywhere in the mouth. Mucocele of the lower lip (lower lip cyst) is the commonest and constitutes 40-80% of the reported cases. It can also occur in the lacrimal gland near the inner corner of the eye, gall bladder, and appendix. Mucocele is a Latin word, which means a mucous-filled cavity. 

Oral mucocele affects the minor (small) salivary glands scattered throughout the mouth, and therefore, you can get it anywhere in the mouth.

What are the demographics of oral mucocele

Oral mucocele affects 0.4 – 0.8% of the population globally. It occurs in 2.4 cases per 1000 individuals in the US, 0.11% in Sweden, and 0.8% in Brazil. Almost 70% of the cases are seen in children and teenagers. Moreover, it rarely affects kids under age one year and it equally affects both genders.

What are the common sites for oral mucocele?

Lower lip is the most common site for mucocele formation. It is followed by the mucocele of the floor of the mouth and under the tongue. Occasionally, mucocele may occur inside the cheek, upper lip, and soft palate.

Mucocele of the lower lip (81%): This accounts for 80% of the cases seen in dental practice and is linked to trauma to the minor salivary gland due to cheek biting. The most common site of mucocele formation is next to premolar teeth, below the corner of the mouth. 

Mucocele inside the cheek (4.8%): Mucocele inside the cheek is commonly associated with cheek biting. Cheek biting traumatizes the cheek and can injure the gland lying superficially under the cheek lining, leading to mucous cyst formation.

Mucocele of the upper lip (0.4%): The Armed Forces Institute of Pathology collected data on 2,339 cases of mucocele and found that only 0.4% of cases involved the upper lip. The most common cause behind the upper lip mucocele is the stone formation in the salivary duct, often seen in the seventh or eighth decade of life. 

Mucocele on soft palate and hard palate: There are numerous minor salivary glands scattered at the junction of soft and hard palate. Any trauma to the palate during eating or salivary gland duct blockage can cause mucocele formation in this area. 

What causes mucocele?

There are two leading causes of oral mucocele; an injury or blockage in the duct of the minor salivary gland. Each insult gives rise to a different kind of mucocele. 

Before going into the details of how a mucocele is formed, let’s first understand the components of a salivary gland. 

A salivary gland is designed to produce secretions to keep the oral lining moist and to break down food.

A salivary gland has two parts: a secretory portion and a ductal system. The secretory portion, resembling a bunch of grapes, produces fluid delivered to the mouth with a duct opening into the oral lining.

Extravasation mucocele

Extravasation mucocele occurs secondary to the damage to the duct of the minor salivary gland due to trauma, leading to the pooling of secretion in the surrounding connective tissue. The inflammatory cells are recruited to the injury site because the body recognizes mucous spill foreign to this site.

The inflammatory cells cordon off the area by forming a layer of intertwined collagen fibers around the mucous, forming a cyst. People who develop extravasation mucocele often present with a history of injury to the lower lip or lip biting. Extravasation mucoceles account for 92% of the reported cases. 

Retention cyst or mucocele

Retention cyst forms due to fluid stagnation in the duct due to duct blockage. The accumulated fluid causes the duct to expand like a balloon next to the obstruction. It constitutes only 8% of the reported cases.

What does mucocele look like (oral mucocele symptoms)?

Oral mucocele appears as a painless, round, soft, transparent, or bluish swelling on the lip or anywhere in the mouth. The bluish hue reflects the congested blood vessels above the bump, making it appear blue. Moreover, the swelling ranges from 6-9mm and fluctuates in size. It can also cause trouble in eating, swallowing, and speech. 

How to get rid of a mucocele? 

Self-Resolution of the oral mucocele 

Extravasation mucocele often resolves without any treatment. It may take a few days to weeks to rupture, forming an ulcer that heals with scarring. If the swelling lasts for more than seven days, get it checked by your dentist to exclude other causes. 

For persistent cases, the mucocele treatments include the following options: 

Surgical removal 

The mucocele is surgically removed using a blade. The area is numbed with a local anesthetic injection. The lip is everted to make it more prominent and resected (cut) at the base of the lump. The whole gland is removed to avoid the chances of recurrence.

The wound is closed with sutures, and the patient is recalled after a week for the suture removal. The removed tissue is then sent for biopsy for tissue examination. 

Cryosurgery

Cryosurgery completely removes the mucocele with low rate of recurrence. During cryosurgery, liquid nitrogen between the temperature of -25°C to -50°C is applied with a spray or probe on the mucocele.

The mucocele is exposed to 5-6 consecutive freeze-thaw cycles, starting from the center and progressing to the edges until the whole lesion turns white.

You will experience mild redness, irritation, and swelling 10 minutes after the freezing cycle. It often takes up to 6 weeks to heal the wound.

Laser vaporization 

Argon and Nd: YAG lasers or 940nm diode lasers melt away the diseased tissue. Laser vaporization is associated with low recurrence rates. It is superior to other treatment methods because of the short procedure, and minimal post-operative bleeding, swelling, and pain. Moreover, the wound is covered with a natural dressing, doesn’t require wound suturing, and heals with little or no scarring. 

Laser excision

Laser excision removes a fully intact mucocele that can be sent for biopsy. During the procedure, local anesthesia is injected around the mucocele, and the laser probe is passed at the bottom of the mucocele to separate it from the underlying tissue. The tissue is sent for biopsy to confirm the diagnosis.

Intralesional Corticosteroid injection

A corticosteroid injection also heals mucocele in 90% of the patients with no recurrence. The injection is deposited into the tissue every week, requiring up to 4 injections to completely heal the tissue. 

Corticosteroids exert an anti-inflammatory effect by inhibiting inflammatory genes and stimulating the transcription of genes encoding for anti-inflammatory proteins.

It also acts as a sclerosing agent, shrinking the dilated salivary duct. 

Marsupialization 

Marsupialization is attempted for large cysts who are at a risk of nerve and arterial damage. It is accomplished by de-roofing the mucocele and stitching its edges with the oral lining. This procedure releases the pressure and allows fluid to drain in the mouth. Moreover, the decompression of the mucocele allows tissues beneath the mucocele to heal, moving the cyst lining upwards. 

It is associated with marked lip disfigurement and takes a month (30 days) to heal.

Micromarsupialization 

Micromarsupialization is the least invasive and safest way to treat mucocele. During the procedure, the mucocele is disinfected and sprayed with a topical anesthesia to numb the swelling. 

Next, the surgeon passes the suture inside the swelling from one side through its widest diameter and passes it out through the other end. The surgical knot is made by tying both ends of the suture, leaving the space between the knot and swelling. The mucocele is then compressed, to expel the accumulated fluid around the suture. 

To prevent any infection, you may be asked to apply 0.5% chlorhexidine gel on the mucocele. You will be called for the next appointment after a week to remove the stitches.

Oral mucocele home treatment 

Mucoceles can’t be treated at home and requires professional help. However, two home remedies may provide relief to ruptured mucoceles.

Warm saline rinses

Salt is an antiseptic, and is available in every household. Warm saline rinses ease inflammation and pain and aid in healing.

How to make saline water: Mix half a teaspoon of sea salt in half a glass of warm water and swish it around the mouth for a minute. Repeat it twice a day for five days. 

Honey application

Honey has an anti-inflammatory and anti-bacterial properties. It can be applied to the ruptured mucocele to soothe the ulcer and prevent the infection.

What to eat after mucocele surgery?

You may experience pain and swelling at the surgical site for the first 48 hours, so it is recommended to eat a soft diet to avoid any injury to the wound. Swelling and discomfort will also affect your ability to chew and close lips properly, so avoid any hard, crunchy food. Also, it would help if you stay away from hot and spicy foods as they can cause burning at the wound site. 

Avoid lip and cheek biting if you have a habit of lip biting, as it can worsen the swelling. Brush your teeth twice daily and rinse your mouth with mouthwash (listerine or any anti-inflammatory mouthwash) three times daily to remove any loose particles stuck in the mouth. 

Why does my mucocele keep coming back?

According to different studies, the recurrence rate of mucocele ranges from 3-18%. The mucoceles on the undersurface of the tongue comes back 50% of the time than the lip and cheek mucoceles. The deep position of the mucocele, and poor field visibility probably lead to high recurrence rate in this region.

Lip and cheek biting are the most common causes of mucocele, and you must quit them to avoid its recurrence. These habits exaggerate under stressful conditions, so stress needs to be managed first. 

Also, surgical mucocele removal is related to a higher rate of mucocele relapse than lasers. 

Moreover, the probability of mucocele recurrence is higher in children and young patients than adults. 

How much does salivary mucocele surgery cost?

The cost of mucocele treatment varies with the size, location, and type of procedure your swelling requires. The price usually falls between $500-$1000 depending upon the procedure. 

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